The interleukin 1 receptor antagonist gene allele 2 as a predictor of pouchitis following colectomy and IPAA in ulcerative colitis

Carter, Martyn J.; Giovine, F. S. Di; Cox, Angela; Goodfellow, Peter; Jones, Simon; Shorthouse, A. J.; Duff, Gordon W.; Lobo, Alan

doi:10.1053/gast.2001.28017

Cited by 118 publications

(49 citation statements)

References 32 publications

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“…33,34 Merret et al 35 reported that allele HLA DRB*0103 was associated with colectomy and subsequent risk for chronic pouchitis. Carter and colleagues 36 reported that the interleukin-1 receptor antagonist gene, allele 2, predicts pouchitis after ileal pouch-anal anastomosis in ulcerative colitis.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Ileal Mucosal Morphology and Inflammation in Patients With Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Kuisma¹,

Mentula²,

Luukkonen³

et al. 2003

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Ileal Mucosal Morphology and Inflammation in Patients With Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Kuisma¹,

Mentula²,

Luukkonen³

et al. 2003

Diseases of the Colon &Amp; Rectum

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“…The implications of these studies include younger age at onset [10,15], younger age at colectomy [4], extensive colitis [12,17,18], backwash ileitis [4,8], extraintestinal manifestations [2,4,8,9,10,11], preoperative steroid use [13,23], smoking status [13,24,25], regular use of nonsteroidal anti-inflammatory drugs [14,24], preoperative perinuclear antineutrophil cytoplasmic antibody positivity [22,25,26], anti-CBir1 flagellin [22], and genetic factors (IL-1 receptor antagonist, NOD2/CARD 15, and TNF genes) [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

“…Some patients with pouchitis reportedly demonstrate alternations in responsiveness to antibiotics, although the majority of them retain their original responsiveness to antibiotic during follow-up [20]. An estimated 5-19% of patients with acute pouchitis develop treatment-refractory or a frequently relapsing form of the disease [28,30,31]. A normal pouch has a possibility of alteration to pouchitis; moreover, acute pouchitis has a possibility of alteration to chronic pouchitis over time.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Okita

Araki²,

Hashimoto³

et al. 2013

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Background: No previous studies have examined predictive factors for chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) with consideration of changes in pouchitis subtypes during follow-up. This study evaluated the independent predictive factors for chronic pouchitis. Methods: A total of 244 consecutive patients who underwent IPAA were enrolled. We assessed the possible associations between pouchitis and clinical factors using Cox proportional hazard regression. Results: 231 patients met the inclusion criteria. 66 (28.5%) patients developed pouchitis. In 9 of 44 (20.4%) patients, antibiotic-responsive pouchitis at the first episode changed into chronic pouchitis after the occurrence of a subsequent episode. The median duration from occurrence of antibiotic-responsive pouchitis to alteration into chronic pouchitis was 502 (range 147-1,697) days. Overall pouchitis was finally classified into 35 acute pouchitis and 31 chronic pouchitis cases. Multivariate analysis revealed that a ≥7.5-g cumulative steroid dose before colectomy and a ≥500-mg monthly steroid dose just before colectomy were significant predictive factors for chronic pouchitis (p = 0.0001 and 0.0095, respectively). Conclusion: Patients with UC and a higher cumulative steroid dose before colectomy or higher monthly steroid dose just before colectomy may have a predictive factor for developing chronic pouchitis.

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“…However, smoking protects against the development of UC, and this effect is not seen in pouchitis [58]. Genetic associations with an increased risk of pouchitis have not yet influenced clinical practice [59,60,61]. …”

Section: The Problematic Pouchmentioning

confidence: 99%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

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Proctitis accounts for a significant proportion of cases of ulcerative colitis (UC), and some patients subsequently develop more extensive disease. However, most patients continue to have limited inflammation, although the changes in the distal colon and rectum can occasionally be severe, and symptoms of increased frequency, rectal bleeding and urgency can be as disabling as they are for patients with more extensive colitis. Furthermore, although symptoms are typically well controlled with standard medications, medically refractory proctitis poses particular problems. Patients generally are not systemically unwell, and there is no added fear of cancer. Therefore, the prospect of colectomy for such limited disease is resisted by patients, physicians and surgeons alike. Unusual therapies, often delivered locally by enema or suppository, have been tested in small case series without definitive outcomes. The pathogenesis of such limited, yet intractable inflammation remains unclear, and the differential diagnosis should be carefully reviewed to ensure that local disease, whether it is infectious, vascular, or a result of injury or degeneration, is not overlooked. Ileo-anal pouch formation is the surgery of choice for about 20% of patients with UC who undergo colectomy. In the majority of cases, this surgery results in an acceptable quality of life and freedom from a stoma. However, in a sizeable minority of cases, pouch dysfunction can cause intractable problems. The causes of pouch dysfunction are varied and must all be considered carefully, particularly in refractory cases. Pouchitis is a common issue and is usually transient and easily treated. However, refractory and chronic pouchitis can be challenging. Ischaemia, injury, infection and Crohn's disease can all cause refractory pouch dysfunction. In a minority of cases, there appears to be no apparent organic pathology, and the presumptive diagnosis is that of a functional pouch disorder. Although it is much rarer, neoplastic changes in the pouch must also be considered, and the risk managed appropriately. The management of both intractable proctitis and the problematic pouch is made more challenging by the wide differential diagnosis that must be considered and by the paucity of high-quality clinical trials to support any one therapy. Key strategies to overcoming these limitations include methodical and systematic investigation and review, and a willingness to tailor therapy to the individual patient. Clinical trials of new treatments should be supported, and data from the experience with small cohorts of patients should be meticulously collected, critically analysed and widely disseminated.

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The interleukin 1 receptor antagonist gene allele 2 as a predictor of pouchitis following colectomy and IPAA in ulcerative colitis

Cited by 118 publications

References 32 publications

Factors Associated With Ileal Mucosal Morphology and Inflammation in Patients With Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Factors Associated With Ileal Mucosal Morphology and Inflammation in Patients With Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Managing Intractable Proctitis and the Problematic Pouch

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